Doctor Name: | MRS. MAUREEN MARY WELLER |
NPI Number: | 1497990436 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R083806 |
Business Practice Address: | 2480 Llewellyn Ave Kimbrough Ambulatory Care Center Fort George G Meade, MD - 207555800 |
Business Phone Number: | 3016778938 |
Business Fax Number: | 3016778486 |
Mailing Address: | 2480 Llewellyn Ave, Kimbrough Ambulatory Care Center FORT GEORGE G MEADE |
State: | MD |
Postal Code: | 207555800 |
Phone Number: | 3016778938 |
Fax Number: | 3016778486 |
NPI Enumeration Date: | 12/04/2008 |
NPI Last Update Date: | 12/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R083806 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |